Final exam Flashcards
Evidence cycle
Ask–acquire–appraise–apply
Hayward’s evidence cycle
Adds in assess
Making a health decision takes what into consideration
Patients circumstance, research evidence, clinical expertise, and patients values/preferences
Background question components
Question + condition
Ex: (what causes) +(Lyme disease)
Foreground question components
“PICO”
Patient +intervention+ comparison + outcome
Diagnostic PICO
P: describe the patient
I: new diagnostic test
C: gold standard test
O: condition to be detected
Prognostic PICO
P: describe patient
I: prognostic factor
C: no prognostic factor
O: health state
Harm PICO
P: describe the patient
I: exposure
C: lack of exposure
O: health state
What is EBCP
Recognize problems, asking questions, evaluating and applying evidence
Clinical research
- offers direct clinical applicability
- designed to replicate authentic/functioning environments
- direct solutions to practical problems
- theory based knowledge
Basic science research
- little clinical relevance
- performed in controlled lab setting
- address theoretical issues
6 Levels of the hierarchy pyramids
- (Lowest-least) in vitro research
- Animal research
- Case series, case studies, surveys
- Cohort studies, case control studies
- RCT
- Meta analyses, systematic reviews
Likelihood of bias
- Systematic reviews
- RCT
- Cohort studies
- Case studies, case series
- (Bottom- most bias) clinical experience
Case control studies or cohort studies
Start with patients who have the disease
Match them with controls
Retrospective
(+) ethnically challenging diseases, rare conditions, limited resources
Best study to show causation
RCT
Meta-analysis or systematic review
Combines the results of many studies
Sensitivity
Probability of a positive test in someone who has the disease
“PID”
In a 4*4 it’s the top left/ total left column
Specificity
Probability of a negative test in someone who doesn’t have the disease
“NIH”
In a 4*4 it’s the bottom right/ total right column
Positive predictive value
Probability that a patient with a positive test really does have the disease
In a 4*4 it’s the top left/ top row
Negative predictive value
The probability that a patient with a negative test really does not have the disease
In a 4*4 it’s the bottom right/bottom row
Positive likelihood ratio
ratio (+in disease/ total in disease)/ (+ no disease/ total no disease)
What are examples of exposures
Survey, file review, interview
Interpretation of + likelihood ratio
1: test is 5 times more likely in patients w/ disease than without
Statistical Test to use if:
Describe one group
Normal: mean, SD
Non-normal: median
Statistical Test to use if:
predict value from another measured variable
normal: simple linear regression or non linear regression
non-normal: non parametric regression
Where do you look for prognostic factors
Table 1
How to detect similar outcome?
Did they use the same method to measure what you are researching
How to find if the follow up sufficiently complete?
Number of starters and follow up with are equal, usually a flow chart
Was there enough time to see factors
Risk ratio, odds ratio?
Rr= times
Odds ratio= association
Paired groups vs unpaired groups
Paired- taking data from 1 patient in two instances, grouping two points of data
Unpaired- not comparing groups of data
Normal distribution of data matches what
A bell curve
T test
Compares two groups
Can be pried or unpaired
Gives t value, but look at p value
P value
Significant significance if p
Mann-Whitney
Difference between 2 unpaired groups
Gives u p r values
Wilcoxon test
Paired groups
ANOVA
Compares 3 or more groups
Report f and p value
Pearson test
Test of association
Spearman
Test of association
Use with non normally distributed data
Linear regression
Asses relationship between 2 or more variables to see if there is a prediction
Doe def
Disease oriented evidence
Poem def
Patient oriented evidence that matters
Doe examples
Insight into patient physiology
Of interest to health provider
BP, reflexes, nervoscope
Poem examples
Self reported by patient
Of interest to patient and clinician
Pain rating, level of function, quality of life
Outcome measure examples
Pain, mental status, disability measurement tool, energy, etc
What type of question do you use to find outcome measure
Background question
Clinimetric properties
Reliability, validity, sensitivity to change, and internal consistency
Don’t try to make up your own outcome measure
Outcome measure for pain
Quadruple vas
NRS
Outcome measure for spine
Oswesty Bourne neck questionnaire Neck disability index Roland Morris scale Headache disability index
Outcome measure for general health
Health status questionnaire
Outcome measure for upper extremity
Upper extremity functional index
Outcome measure for lower extremity
Foot ankle outcome score
Hip dysfunction and osteoarthritis outcome score
Knee and osteoarthritis outcome score
Lower extremity functional scale
Outcomes for general extremity
Rheumatoid and arthritis outcome score
VAS
10 cm line
Please make a vertical line where your pain is at
Vertical VAS works best for who
Elderly
NRS
Scale 1-10
Quadruple VAS
Pain right now?
Typical or average pain?
Pain at its best?
Pain at its worst?
Pain diagrams
Body and you color in where the pain is
ODI
10 sections of daily activity 6 choices in each Scored 0-5 Add each section for overall disability Multiply by 2 for %
NDI
Neck disability
Modified ODI by Howard Vernon
RMQ
Low back disability
24 statements
Bournemouth
7 items
Each on scale of 10
Take total points and divide by 70%
Headache disability index
2 subscales
Emotional and functional
UEFI or LEFI
20 items
Scored 0-4
Total score /80 x 100=%
Score gets higher with lower pain
Foot and ankle, hip dysfunction, knee, RA
6 areas- symptoms, stiffness, pain, ADL, sports/recreation, quality of life
Scored 0-4
Total score /168 x 100=%
Needs a change of 10% for meaningful improvement
General Health Status Questionnaire
8 sub-scales of general health
2 summary measures
overall score
3 individual diagnostic questions
8 sub-scales of general health
physical functioning, role physical, body pain, general health, vitality, social functioning, role emotional, mental health
2 summary measures
Physical health and emotional health
